UnitedHealth Group

opencollection: 1.0.0
info:
  name: UnitedHealth Group Optum API
  version: R4
request:
  auth:
    type: bearer
    token: '{{bearerToken}}'
items:
- info:
    name: Patient Access
    type: folder
  items:
  - info:
      name: UnitedHealth Group Get Patient Demographics
      type: http
    http:
      method: GET
      url: https://api.uhc.com/fhir/R4/Patient/:id
      params:
      - name: id
        value: ''
        type: path
        description: FHIR Patient resource logical ID (maps to member ID)
    docs: Retrieve FHIR R4 Patient resource for a UnitedHealthcare member including demographic information, member identifiers,
      contact details, and language preferences as required by the CMS Patient Access rule.
  - info:
      name: UnitedHealth Group List Claims as Explanation of Benefit
      type: http
    http:
      method: GET
      url: https://api.uhc.com/fhir/R4/ExplanationOfBenefit
      params:
      - name: patient
        value: ''
        type: query
        description: Patient resource ID to retrieve ExplanationOfBenefits for
      - name: type
        value: ''
        type: query
        description: Claim type filter (professional, institutional, pharmacy, oral)
      - name: _lastUpdated
        value: ''
        type: query
        description: Filter by last updated date/time in FHIR date format
      - name: service-date
        value: ''
        type: query
        description: Filter by service date (FHIR date format)
      - name: _count
        value: ''
        type: query
        description: Maximum number of results per page
      - name: _offset
        value: ''
        type: query
        description: Pagination offset
    docs: Retrieve FHIR R4 ExplanationOfBenefit (EOB) resources for a member providing comprehensive claims data including
      services rendered, diagnosis codes, procedure codes, amounts billed and paid, and adjudication details. Supports CMS
      Patient Access rule compliance for claims data access.
  - info:
      name: UnitedHealth Group List Member Coverage
      type: http
    http:
      method: GET
      url: https://api.uhc.com/fhir/R4/Coverage
      params:
      - name: patient
        value: ''
        type: query
        description: Patient resource ID
      - name: status
        value: ''
        type: query
        description: Coverage status filter
    docs: Retrieve FHIR R4 Coverage resources for a member including current and historical insurance coverage details, plan
      names, benefit periods, group and member identifiers, and payer information across UnitedHealthcare commercial, Medicare,
      and Medicaid lines of business.
- info:
    name: Clinical Data
    type: folder
  items:
  - info:
      name: UnitedHealth Group List Member Conditions
      type: http
    http:
      method: GET
      url: https://api.uhc.com/fhir/R4/Condition
      params:
      - name: patient
        value: ''
        type: query
        description: Patient resource ID
      - name: clinical-status
        value: ''
        type: query
        description: Condition clinical status filter
      - name: _count
        value: ''
        type: query
        description: Maximum number of results
    docs: Retrieve FHIR R4 Condition resources for a member representing active and historical health conditions, diagnoses,
      and clinical problems as reflected in claims data and clinical records available through the Patient Access API.
- info:
    name: Provider Directory
    type: folder
  items:
  - info:
      name: UnitedHealth Group List Network Practitioners
      type: http
    http:
      method: GET
      url: https://api.uhc.com/fhir/R4/Practitioner
      params:
      - name: name
        value: ''
        type: query
        description: Provider name search
      - name: identifier
        value: ''
        type: query
        description: NPI or other identifier
      - name: specialty
        value: ''
        type: query
        description: Provider specialty taxonomy code
      - name: address-state
        value: ''
        type: query
        description: State code for geographic filter
      - name: _count
        value: ''
        type: query
        description: Maximum number of results
    docs: Search the UnitedHealthcare FHIR R4 Provider Directory for individual healthcare practitioners by name, NPI, specialty,
      or geographic location. Implements the Da Vinci PDex Plan Net Implementation Guide for provider directory services.
  - info:
      name: UnitedHealth Group List Network Organizations
      type: http
    http:
      method: GET
      url: https://api.uhc.com/fhir/R4/Organization
      params:
      - name: name
        value: ''
        type: query
        description: Organization name search
      - name: type
        value: ''
        type: query
        description: Organization type code
      - name: address-state
        value: ''
        type: query
        description: State code filter
      - name: _count
        value: ''
        type: query
        description: Maximum number of results
    docs: Search the UnitedHealthcare FHIR R4 Provider Directory for healthcare organizations including hospitals, medical
      groups, and specialty facilities. Supports filtering by organization type, name, and location. Implements Da Vinci PDex
      Plan Net IG.
- info:
    name: Drug Formulary
    type: folder
  items:
  - info:
      name: UnitedHealth Group List Formulary Drug Coverage
      type: http
    http:
      method: GET
      url: https://api.uhc.com/fhir/R4/MedicationKnowledge
      params:
      - name: code
        value: ''
        type: query
        description: RxNorm drug code
      - name: drug-name
        value: ''
        type: query
        description: Drug name search string
      - name: tier
        value: ''
        type: query
        description: Formulary tier number filter
      - name: _count
        value: ''
        type: query
        description: Maximum number of results
    docs: Retrieve drug formulary information from the UnitedHealthcare FHIR R4 Drug Formulary API including coverage tiers,
      formulary status, prior authorization requirements, quantity limits, and step therapy requirements for prescription
      drugs. Implements the Da Vinci Drug Formulary IG.
bundled: true